Carbonic Anhydrase IX Targeting Mn(II)-Based Magnetic Resonance Molecular Imaging Probe for Hypoxia Tumors.

Physiological hypoxic conditions in the tumor microenvironment and consequential overexpression of carbonic anhydrase IX (CA IX) are two characteristics shared by numerous types of solid malignant tumors. Early detection with hypoxia assessment is crucial to improve the prognosis and therapy outcomes of hypoxia tumors. Herein, using acetazolamide (AZA) as a CA IX-targeting moiety, we design and synthesize an Mn(II)-based MR imaging probe (named AZA-TA-Mn) incorporating AZA and two Mn(II) chelates of Mn-TyEDTA on a rigid triazine (TA) scaffold. The per Mn relaxivity of AZA-TA-Mn is 2-fold higher than its monomeric Mn-TyEDTA, which allows it for low-dose imaging of hypoxic tumors. In a xenograft mice model of esophageal squamous cell carcinoma (ESCC), a low dosage of AZA-TA-Mn (0.05 mmol/kg) can selectively produce prolonged and stronger contrast enhancement in the tumor compared to the non-specific Gd-DTPA (0.1 mmol/kg). A competition study of co-injection of free AZA and Mn(II) probes confirms the in vivo tumor selectivity of AZA-TA-Mn, resulting in a more than 2.5-fold decreased tumor-to-muscle contrast-to-noise ratio (ΔCNR) at 60 min post-injection. MR imaging results were further supported by the quantitative analysis of Mn tissue levels, as the co-injection of free AZA resulted in significantly reduced Mn accumulation in tumor tissues. Finally, immunofluorescence staining of tissue sections confirms the positive correlation between the tumor accumulation of AZA-TA-Mn and CA IX overexpression. Hence, using CA IX as the hypoxia biomarker, our results illustrate a practical strategy for the development of novel imaging probes for hypoxic tumors.

A novel model based on liver/spleen volumes and portal vein diameter on MRI to predict variceal bleeding in HBV cirrhosis.

OBJECTIVE: To develop a novel logistic regression model based on liver/spleen volumes and portal vein diameter measured on magnetic resonance imaging (MRI) for predicting oesophagogastric variceal bleeding (OVB) secondary to HBV cirrhosis. METHODS: One hundred eighty-five consecutive cirrhotic patients with hepatitis B undergoing abdominal contrast-enhanced MRI were randomly divided into training cohort (n = 130) and validation cohort (n = 55). Spleen volume, total liver volume, four liver lobe volumes, and diameters of portal venous system were measured on MRI. Ratios of spleen volume to total liver and to individual liver lobe volumes were calculated. In training cohort, univariate analyses and binary logistic regression analyses were to determine independent predictors. Performance of the model for predicting OVB constructed based on independent predictors from training cohort was evaluated by receiver operating characteristic (ROC) analysis, and was validated by Kappa test in validation cohort. RESULTS: OVB occurred in 42 and 18 individuals in training and validation cohorts during the 2 years' follow-up, respectively. An OVB prediction model was constructed based on the independent predictors including right liver lobe volume (RV), left gastric vein diameter (LGVD) and portal vein diameter (PVD) (odds ratio = 0.993, 2.202 and 1.613, respectively; p-values < 0.001 for all). The logistic regression model equation (-0.007 × RV + 0.79 × LGVD + 0.478 × PVD-6.73) for predicting OVB obtained excellent performance with an area under ROC curve of 0.907. The excellent performance was confirmed by Kappa test with K-value of 0.802 in validation cohort. CONCLUSION: The novel logistic regression model can be reliable for predicting OVB. KEY POINTS: • Patients with oesophagogastric variceal bleeding are mainly characterized by decreased right lobe volume, and increased spleen volume and diameters of portal vein system. • The right liver lobe volume, left gastric vein diameter and portal vein diameter are the independent predictors of oesophagogastric variceal bleeding. • The novel model developed based on the independent predictors performed well in predicting oesophagogastric variceal bleeding with an area under the receiver operating characteristic curve of 0.907.

Early assessment of acute kidney injury in severe acute pancreatitis with multimodal DWI: an animal model.

OBJECTIVES: To evaluate the feasibility of multimodal diffusion-weighted imaging (DWI) for detecting the occurrence and severity of acute kidney injury (AKI) caused by severe acute pancreatitis (SAP) in rats. METHODS: SAP was induced in thirty rats by the retrograde injection of 5.0% sodium taurocholate through the biliopancreatic duct. Six rats underwent MRI of the kidneys 24 h before and 2, 4, 6, and 8 h after this AKI model was generated. Conventional and functional MRI sequences were used, including intravoxel incoherent motion imaging (IVIM), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DTI). The main DWI parameters and histological results were analyzed. RESULTS: The fast apparent diffusion coefficient (ADC) of the renal cortex was significantly reduced at 2 h, as was the fractional anisotropy (FA) value of the renal cortex on DTI. The mean kurtosis (MK) values for the renal cortex and medulla gradually increased after model generation. The renal histopathological score was negatively correlated with the medullary slow ADC, fast ADC, and perfusion scores for both the renal cortex and medulla, as were the ADC and FA values of the renal medulla in DTI, whereas the MK values of the cortex and medulla were positively correlated (r = 0.733, 0.812). Thus, the cortical fast ADC, medullary MK, FADTI, and slow ADC were optimal parameters for diagnosing AKI. Of these parameters, cortical fast ADC had the highest diagnostic efficacy (AUC = 0.950). CONCLUSIONS: The fast ADC of the renal cortex is the core indicator of early AKI, and the medullary MK value might serve as a sensitive biomarker for grading renal injury in SAP rats. CLINICAL RELEVANCE STATEMENT: The multimodal parameters of renal IVIM, DTI, and DKI are potential beneficial for the early diagnosis and severity grading of renal injury in SAP patients. KEY POINTS: • The multimodal parameters of renal DWI, including IVIM, DTI, and DKI, may be valuable for the noninvasive detection of early AKI and the severity grading of renal injury in SAP rats. • Cortical fast ADC, medullary MK, FA, and slow ADC are optimal parameters for early diagnosis of AKI, and cortical fast ADC has the highest diagnostic efficacy. • Medullary fast ADC, MK, and FA as well as cortical MK are useful for predicting the severity grade of AKI, and the renal medullary MK value exhibits the strongest correlation with pathological scores.

Actin-ring segment switching drives nonadhesive gap closure.

Gap closure to eliminate physical discontinuities and restore tissue integrity is a fundamental process in normal development and repair of damaged tissues and organs. Here, we demonstrate a nonadhesive gap closure model in which collective cell migration, large-scale actin-network fusion, and purse-string contraction orchestrate to restore the gap. Proliferative pressure drives migrating cells to attach onto the gap front at which a pluricellular actin ring is already assembled. An actin-ring segment switching process then occurs by fusion of actin fibers from the newly attached cells into the actin cable and defusion from the previously lined cells, thereby narrowing the gap. Such actin-cable segment switching occurs favorably at high curvature edges of the gap, yielding size-dependent gap closure. Cellular force microscopies evidence that a persistent rise in the radial component of inward traction force signifies successful actin-cable segment switching. A kinetic model that integrates cell proliferation, actin fiber fusion, and purse-string contraction is formulated to quantitatively account for the gap-closure dynamics. Our data reveal a previously unexplored mechanism in which cells exploit multifaceted strategies in a highly cooperative manner to close nonadhesive gaps.

Forensic age prediction and age classification for critical age thresholds via 3.0T magnetic resonance imaging of the knee in the Chinese Han population.

OBJECTIVES: To assess the performance of knee MRI for forensic age prediction and classification for 12-, 14-, 16-, and 18-year thresholds. METHODS: The ossification stages of distal femoral epiphyses and proximal tibial epiphyses were assessed using an integrated staging system by Schmeling et al. and Kellinghaus et al. for knee 3.0T MRI with T1-weighted turbo spin-echo (T1-TSE) in sagittal orientation among 852 Chinese Han individuals (483 males and 369 females) aged 7-30 years. Regression models for age prediction were constructed and their performances were evaluated based on mean absolute deviation (MAD) values. In addition, the performances of age classification were assessed using receiver operating characteristic (ROC) analyses. RESULTS: The intra- and inter-observer agreement levels were very good (κ > 0.80). The complete fusion of those two types of epiphyses took place before 18.0 years in our study participants. The minimum MAD values were 2.51 years (distal femur) and 2.69 years (proximal tibia) in males, and 2.75 years (distal femur) and 2.87 years (proximal tibia) in females. The specificity values of constructed prediction models were all above 90% for the 12-, 14-, and 16-year thresholds, compared to the 74.8-84.6% for the 18-year threshold. Better performances of age prediction and classification were observed in males by distal femoral epiphyses. CONCLUSIONS: Ossification stages via 3.0T MRI of the knee with T1-TSE sequence using an integrated staging system could be a reliable noninvasive method for age prediction or for age classification for 12-, 14-, and 16-year thresholds, especially in males by distal femoral epiphyses. However, assessments based on the full bony fusion of the distal femoral epiphysis and proximal tibial epiphysis seemed not reliable for age classification for the 18-year threshold in the Chinese Han population.

Noninvasive evaluation of early diabetic nephropathy using diffusion kurtosis imaging: an experimental study.

OBJECTIVES: To evaluate the value of renal diffusion kurtosis imaging (DKI) in the diagnosis of early diabetic nephropathy (DN) in a rat model. MATERIALS AND METHODS: Forty male Zucker diabetic fatty rats that spontaneously developed type 2 diabetes mellitus (DM) and 20 age-matched nondiabetic lean Zucker rats were included. Renal DKI scans and histological examinations were performed on the rats in batches at the end of the 4th, 8th, 12th, 16th, and 20th week after DM model was built. Based on renal histopathological appearance, included animals were divided into three groups: a nondiabetic control group, a DM group without DN, and an early DN group. Mean kurtosis (MK) and mean diffusivity (MD) values of renal cortex and medulla were analyzed statistically. RESULTS: MK values of renal cortex and medulla tended to increase from the control group to the early DN group, respectively, while MD values tended to decrease. The cutoff MD and MK values of renal cortex and medulla showed different values in discriminating early DN from controls. Among them, cutoff MK value of medulla of 0.62 was the best parameter (sensitivity, 93.9%; specificity, 96.4%; and area under the curve, 0.95). For discriminate early DN from DM without DN and DM without DN from controls, cutoff MK value of renal cortex or medulla achieved an area under the curve of 0.76-0.85. CONCLUSIONS: MR DKI may be valuable for the noninvasive detection of early DN, and MK value might serve as a more sensitive biomarker of early DN than MD value. KEY POINTS: • In this article, diffusion kurtosis imaging (DKI) was used to detect the changes in the kidneys due to early diabetic nephropathy (DN). • MR DKI may be valuable for the noninvasive detection of early DN. • The mean kurtosis values of renal cortex and medulla might serve as a more sensitive biomarker of early DN than the mean diffusivity values.

Radiomics model of contrast-enhanced MRI for early prediction of acute pancreatitis severity.

BACKGROUND: Computed tomography (CT) or MR images may cause the severity of early acute pancreatitis (AP) to be underestimated. As an innovative image analysis method, radiomics may have potential clinical value in early prediction of AP severity. PURPOSE: To develop a contrast-enhanced (CE) MRI-based radiomics model for the early prediction of AP severity. STUDY TYPE: Retrospective. SUBJECTS: A total of 259 early AP patients were divided into two cohorts, a training cohort (99 nonsevere, 81 severe), and a validation cohort (43 nonsevere, 36 severe). FIELD STRENGTH/SEQUENCE: 3.0T, T1 -weighted CE-MRI. ASSESSMENT: Radiomics features were extracted from the portal venous-phase images. The "Boruta" algorithm was used for feature selection and a support vector machine model was established with optimal features. The MR severity index (MRSI), the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the bedside index for severity in acute pancreatitis (BISAP) were calculated to predict the severity of AP. STATISTICAL TESTS: Independent t-test, Mann-Whitney U-test, chi-square test, Fisher's exact tests, Boruta algorithm, receiver operating characteristic analysis, DeLong test. RESULTS: Eleven potential features were chosen to develop the radiomics model. In the training cohort, the area under the curve (AUC) of the radiomics model, APACHE II, BISAP, and MRSI were 0.917, 0.750, 0.744, and 0.749, and the P value of AUC comparisons between the radiomics model and scoring systems were all less than 0.001. In the validation cohort, the AUC of the radiomics model, APACHE II, BISAP, and MRSI were 0.848, 0.725, 0.708, and 0.719, respectively, and the P value of AUC comparisons were 0.96 (radiomics vs. APACHE II), 0.40 (radiomics vs. BISAP), and 0.46 (radiomics vs. MRSI). DATA CONCLUSION: The radiomics model had good performance in the early prediction of AP severity. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:397-406.

Bioinspired Polymer Nanocomposites Exhibit Giant Energy Density and High Efficiency at High Temperature.

Polymer dielectrics are ubiquitous in advanced electric energy storage systems. However, the relatively low operating temperature significantly menaces their widespread application at high temperatures, such as for hybrid vehicles and aerospace power electronics. Spider silk, a natural nanocomposite comprised of biopolymer chains and crystal protein nanosheets combined by multiple interfacial interactions, exhibits excellent mechanical properties even at elevated temperatures. Inspired by the hierarchical nanostructure of spider silk, poly(aryl ether sulfone) is anchored to the surface of wide bandgap artificial nanosheets to prepare the nanocomposites with nanoconfinement effect. The bioinspired strategy successfully improves the mechanical and electrical performances of the nanocomposite. Owing to the structural-enabled enhancements, the nanocomposites exhibit excellent breakdown strength and electrical energy storage performance at high temperatures. In detail, giant discharged energy density (2.7 J cm-3 ) and high charge-discharge efficiency (>90%) are simultaneously achieved at 150 °C and 400 MV m-1 . Notably, under 500 MV m-1 , the discharged energy density reaches 4.2 J cm-3 , which is the record high discharged energy density among polymer-based dielectrics at 150 °C. This work demonstrates a viable strategy to design high-temperature polymer dielectrics by constructing nanoconfinement in the nanocomposites.

Radiomics model of contrast-enhanced computed tomography for predicting the recurrence of acute pancreatitis.

OBJECTIVES: To predict the recurrence of acute pancreatitis (AP) by constructing a radiomics model of contrast-enhanced computed tomography (CECT) at AP first attack. METHODS: We retrospectively enrolled 389 first-attack AP patients (271 in the primary cohort and 118 in the validation cohort) from three tertiary referral centers; 126 and 55 patients endured recurrent attacks in each cohort. Four hundred twelve radiomics features were extracted from arterial and venous phase CECT images, and clinical characteristics were gathered to develop a clinical model. An optimal radiomics signature was chosen using a multivariable logistic regression or support vector machine. The radiomics model was developed and validated by incorporating the optimal radiomics signature and clinical characteristics. The performance of the radiomics model was assessed based on its calibration and classification metrics. RESULTS: The optimal radiomics signature was developed based on a multivariable logistic regression with 10 radiomics features. The classification accuracy of the radiomics model well predicted the recurrence of AP for both the primary and validation cohorts (87.1% and 89.0%, respectively). The area under the receiver operating characteristic curve (AUC) of the radiomics model was significantly better than that of the clinical model for both the primary (0.941 vs. 0.712, p = 0.000) and validation (0.929 vs. 0.671, p = 0.000) cohorts. Good calibration was observed for all the models (p > 0.05). CONCLUSIONS: The radiomics model based on CECT performed well in predicting AP recurrence. As a quantitative method, radiomics exhibits promising performance in terms of alerting recurrent patients to potential precautions. KEY POINTS: • The incidence of recurrence after an initial episode of acute pancreatitis is high, and quantitative methods for predicting recurrence are lacking. • The radiomics model based on contrast-enhanced computed tomography performed well in predicting the recurrence of acute pancreatitis. • As a quantitative method, radiomics exhibits promising performance in terms of alerting recurrent patients to the potential need to take precautions.

Radiographic Osteoarthritis Prevalence Over Ten Years After Anterior Cruciate Ligament Reconstruction.

The purpose of this study was to conduct an up-to-date systematic review and meta-analysis of radiographic knee osteoarthritis (OA) over minimal ten years after ACL reconstruction. The database of Pubmed and the Ovid was adopted. The radiographic knee OA over minimal ten years after ACL reconstruction was systematically reviewed. Both the ipsilateral and contralateral knees were evaluated referring to the tibiofemoral joint (TFJ), the patellofemoral joint (PFJ), and the overall knee OA prevalence. Nineteen studies were included for review, with nine screened for the meta-analysis. The overall knee OA rate ranged from 8.3-79.2%, meanly 51.6% on the ipsilateral side; ranged from 3.6-35.7%, meanly 15.5% on the contralateral side. Compared to the contralateral side, the RR of developing radiographic OA was 3.73 (P<0.01) for the overall knee, 2.88 (P<0.01) for TFJ, and 2.42 (P<0.01) for PFJ. Ipsilaterally, the RR of developing TFJ radiographic OA was 1.15 (P<0.01) compared to that of the PFJ. Over a minimum of 10 years after surgery, more than half the cases developed overall radiographic OA on the ipsilateral knee, which was nearly four times higher than the contralateral side. On the ipsilateral knee, the TFJ was most affected.

Tumour volume of resectable oesophageal squamous cell carcinoma measured with MRI correlates well with T category and lymphatic metastasis.

OBJECTIVES: To determine association of gross tumour volume (GTV) of resectable oesophageal squamous cell carcinoma (SCC) measured on T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI) and diffusion-weighted imaging (DWI) with T category and lymphatic metastasis (LM). METHODS: Sixty oesophageal SCC patients underwent fat-suppressed T2WI, CE-T1WI and DWI with b values of 0, 500 and 800 s/mm2. GTV was measured on three sequences. Statistical analyses were performed to determine association of GTV with T category and LM. RESULTS: Spearman's rank correlation analysis showed positive association of GTV with T category and LM (all p values < 0.01). Differences in GTV were found between T1 and T2 or T3 categories shown by Kruskal-Wallis H and one-way ANOVA tests, and between T1/T2 and T3 and between tumours with and without LM by Mann-Whitney U tests (all p values < 0.05). Receiver operating characteristic analyses showed cut-off GTVs of 5.795, 5.276 and 10.11 cm3 on CE-T1WI could better differentiate T1 from T2 categories, T1 from T3, and T1-2 from T3 than those of 7.066, 7.045 and 8.504 cm3 on T2WI, of 5.793, 6.609 and 6.989 cm3 on DWI with b value of 500 s/mm2, and of 4.156, 4.519 and 4.985 cm3 with b value of 800 s/mm2, respectively. Cut-off of 10.462 cm3 on DWI with b value of 500 s/mm2 could better identify LM than of 12.38, 8.793 and 9.600 cm3 on T2WI, CE-T1WI and DWI with b value of 800 s/mm2, respectively. CONCLUSIONS: GTVs on T2WI, CE-T1WI and DWI are associated with T category of and LM of oesophageal SCC. KEY POINTS: • GTV is associated with T category and lymphatic metastasis of oesophageal SCC • GTV measured on contrast-enhanced T 1 -weighted imaging better identifies T category • GTV measured on DWI with b value of 500 s/mm 2 better identifies lymphatic metastasis.

Time From Injury to Surgery Affects Graft Maturation Following Posterior Cruciate Ligament Reconstruction With Remnant Preservation: A Magnetic Resonance Imaging-Based Study.

PURPOSE: To evaluate the clinical outcomes and graft maturation following posterior cruciate ligament reconstruction (PCLR) with preserved remnant and further analyze the correlated factors affecting graft maturation. METHODS: Consecutive patients who underwent unilateral single-bundle PCLR with remnant preservation from January 2011 to October 2014 by the same senior doctor using tibialis anterior allografts and same surgical technique were included. At a follow-up of more than 2 years, range of motion (ROM) and posterior laxity assessed by posterior drawer test and the KT-1000 arthrometer were examined. Tegner, Lysholm, and International Knee Documentation Committee scores were evaluated. The graft maturation was assessed by a 3.0-T magnetic resonance imaging. Overall correlation analyses and multivariate regression analysis were performed to identify correlated factors of graft maturation, and then subgroups were divided and analyzed according to significant risk factor. RESULTS: Forty-three (84.3%) of 51 enrolled patients were successfully followed up (38.4 months, 24-54 months). All clinical scores improved significantly, and there were no complications. The results of KT-1000 difference revealed significant decline of posterior laxity (9.4 ± 1.5 vs 2.2 ± 1.5 mm; P < .001). The MRI evaluation confirmed no ligament retears. Both correlation and regression analyses showed time from injury to surgery had a positive, statistically significant weak correlation with the signal intensity score (R = 0.38, P = .012; coefficient = 0.10; P = .036). Subgroup (group 1: time from injury to surgery <3 months; group 2: 3-6 months; group 3: 6-12 months; group 4: ≥12 months) analysis showed there were no significant differences of clinical outcomes between subgroups, while MRI signal intensity was significantly lower in the group with shorter time from injury to surgery (P = .02). CONCLUSIONS: The remnant-preserved PCLR resulted in satisfactory clinical outcomes and graft maturation at a mean follow-up of 38.4 months. The time from injury to surgery showed a weak positive correlation with postoperative graft signal intensity on MRI. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Two-Fold Anisotropy Governs Morphological Evolution and Stress Generation in Sodiated Black Phosphorus for Sodium Ion Batteries.

Phosphorus represents a promising anode material for sodium ion batteries owing to its extremely high theoretical capacity. Recent in situ transmission electron microscopy studies evidenced anisotropic swelling in sodiated black phosphorus, which may find an origin from the two intrinsic anisotropic properties inherent to the layered structure of black phosphorus: sodium diffusional directionality and insertion strain anisotropy. To understand the morphological evolution and stress generation in sodiated black phosphorus, we develop a chemo-mechanical model by incorporating the intrinsic anisotropic properties into the large elasto-plastic deformation. Our modeling results reveal that the apparent morphological evolution in sodiated black phosphorus is critically controlled by the coupled effect of the two intrinsic anisotropic properties. In particular, sodium diffusional directionality generates sharp interphases along the [010] and [001] directions, which constrain anisotropic development of the insertion strain. The coupled effect renders distinctive stress-generation and fracture mechanisms when sodiation starts from different crystal facets. In addition to providing a powerful modeling framework for sodiation and lithiation of layered structures, our findings shed significant light on the sodiation-induced chemo-mechanical degradation of black phosphorus as a promising anode for the next-generation sodium ion batteries.

Enhanced Fibroblast Cellular Ligamentization Process to Polyethylene Terepthalate Artificial Ligament by Silk Fibroin Coating.

Artificial ligaments utilized in reconstruction of anterior cruciate ligament (ACL) are usually made of polyethylene terepthalate (PET) because of its good mechanical properties in vivo. However, it was found that the deficiencies in hydrophilicity and biocompatibility of PET hindered the process of ligamentization. Therefore, surface modification of the PET is deemed as a solution in resolving such problem. Silk fibroin (SF), which is characterized by good biocompatibility and low immunogenicity in clinical applications, was utilized to prepare a coating on the PET ligament (PET+SF) in this work. At first, decrease of hydrophobicity and appearance of amino groups were found on the surface of artificial PET ligament after coating with SF. Second, mouse fibroblasts were cultured on the two different kinds of ligament in order to clarify the possible effect of SF coating. It was proved that mouse fibroblasts display better adhesion and proliferation on PET+SF than PET ligament according to the results of several technical methods including SEM observation, cell adhesive force and spread area test, and mRNA analysis. Meanwhile, methylthiazolyldiphenyl-tetrazolium bromide and DNA content tests showed that biocompatibility of PET+SF is better than PET ligament. In addition, collagen deposition tests also indicated that the quantity of collagen in PET+SF is higher than PET ligament. Based on these results, it can be concluded that SF coating is suggested to be an effective approach to modify the surface of PET ligament and enhance the "ligamentization" process in vivo accordingly.

Thickness of soft tissue of lower extremities measured with magnetic resonance imaging as a new indicator for staging unilateral secondary lower extremity lymphedema.

BACKGROUND: Chronic progressive swelling of the lower extremity due to secondary lower extremity lymphedema (LEL) can affect a patient's quality of life, both physically and psychologically. A feasible and reproducible method for detecting and staging LEL will facilitate decision-making about appropriate management strategies. PURPOSE: To determine whether the thickness of the soft tissues of the lower extremities, measured with magnetic resonance imaging (MRI), could stage unilateral secondary LEL. MATERIAL AND METHODS: Seventy-two women with unilateral LEL and 22 participants without LEL underwent lower extremity MRI after treatment of uterine malignancies. LEL was classified clinically as stage 0, 1, 2, or 3. On fat-suppressed T2-weighted mid-axial images of calves and thighs, the total thickness of the soft tissue (TT), muscle thickness (MT), subcutaneous tissue thickness (STT), and the differences in TT (DTT), MT (DMT), and STT (DSTT) values and corresponding measurements in the contralateral lower extremity, were obtained and analyzed statistically for staging LEL. RESULTS: There was a trend for the TT and STT of the affected calf and thigh to increase with increasing LEL stage. These parameters were strongly and moderately correlated with LEL stage, respectively (P < 0.001). Both the DTT and DSTT of the calves or thighs were strongly correlated with LEL stage (P < 0.001). Among the parameters, the DSTT of the calves could best stage LEL, with an area under the receiver operating curve of more than 0.89. CONCLUSION: The DSTT of the calves could be recommended as an informative indicator for staging LEL.

Liver dynamic contrast-enhanced MRI for staging liver fibrosis in a piglet model.

PURPOSE: To determine whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could monitor progression of liver fibrosis in a piglet model, and which DCE-MRI parameter is most accurate for staging this disease. MATERIALS AND METHODS: Sixteen piglets were prospectively used to model liver fibrosis and underwent liver DCE-MRI followed by biopsy on the 0, 5th, 9th, 16th, and 21st weekends after modeling of fibrosis. Time of peak (TOP), time to peak (TTP), positive enhancement integral (PEI), maximum slope of increase (MSI), and maximum slope of decrease (MSD) were measured and statistically analyzed for the monitoring and staging. RESULTS: As fibrosis progresses, TOP and TTP tended to increase, whereas MSI, MSD, and PEI tended to decrease (all P < 0.05). TOP, TTP, and MSI could discriminate fibrosis stage 0 from 1-4, 0-1 from 2-4, 0-2 from 3-4, and 0-3 from 4; PEI could distinguish the above-mentioned stages except 0-3 from 4; and MSD could distinguish stage 0-3 from 4, and 0 from 1-4 (all P < 0.05). For predicting stage ≥1, ≥2, and ≥3, the area under receiver operating characteristic curve (AUC) of MSI was largest among all parameters; for stage 4 AUC of TTP was largest. CONCLUSION: DCE-MRI has the potential to dynamically stage progression of liver fibrosis.

Diameters of left gastric vein and its originating vein on magnetic resonance imaging in liver cirrhosis patients with hepatitis B: Association with endoscopic grades of esophageal varices.

AIM: To determine whether diameters of the left gastric vein (LGV) and its originating vein are associated with endoscopic grades of esophageal varices. METHODS: Ninety-eight liver cirrhotic patients with hepatitis B undergoing magnetic resonance (MR) portography, and upper gastrointestinal endoscopy for grading esophageal varices were enrolled. Diameters of the LGV and its originating vein - the splenic vein (SV) or portal vein (PV) - were measured on MR imaging. Statistical analyses were performed to identify the association of the diameters with the endoscopic grades. RESULTS: Univariate analysis showed that the SV was predominantly the originating vein of the LGV, and diameters of the LGV and SV were associated with grades of esophageal varices. Diameters of the LGV (P = 0.023, odds ratio [OR] = 1.583) and SV (P = 0.012, OR = 2.126) were independent risk factors of presence of the varices. Cut-off LGV diameters of 5.1 mm, 5.9 mm, 6.6 mm, 7.1 mm, 7.8 mm and 5.8 mm; or cut-off SV diameters of 7.3 mm, 7.9 mm, 8.4 mm, 9.5 mm, 10.7 mm and 8.3 mm, could discriminate grades 0 from 1, 0 from 2, 0 from 3, 1 from 3, 2 from 3, and 0-1 from 2-3, respectively. CONCLUSION: Diameters of the LGV and SV are associated with endoscopic grades of esophageal varices.

Validity of soft-tissue thickness of calf measured using MRI for assessing unilateral lower extremity lymphoedema secondary to cervical and endometrial cancer treatments.

AIM: To determine whether soft-tissue thickness of the calf measured using MRI could be valid for assessing unilateral lower extremity lymphoedema (LEL) secondary to cervical and endometrial cancer treatments. MATERIALS AND METHODS: Seventy women with unilateral LEL and 25 without LEL after cervical or endometrial cancer treatments underwent MRI examinations of their calves. Total thickness of soft-tissue (TT), muscle thickness (MT), and subcutaneous tissue thickness (STT) of the calf, and the difference between the affected and contralateral unaffected calf regarding TT (DTT), MT (DMT), and STT (DSTT) were obtained using fat-suppressed T2-weighted imaging in the middle of the calves. The volume of the calf and difference in volume (DV) between calves were obtained by the method of water displacement. Statistical analysis was performed to determine the validity of MRI measurements by volume measurements in staging LEL. RESULTS: There was a close correlation between volume and TT for the affected (r = 0.927) or unaffected calves (r = 0.896). STT of the affected calf, and DTT or DSTT of the calves were closely correlated with volume of the affected calf or DV of the calves (all p < 0.05). Multivariate analysis showed significant differences in TT, STT, volume of the affected calf, DTT, DSTT, and DV between stages except in volume of the affected calf or in DV between stage 0 and 1. For staging LEL, DSTT showed the best discrimination ability among all the parameters. CONCLUSIONS: Soft-tissue thickness of the calf measured at MRI could be valid for quantitatively staging unilateral LEL, and DSTT of the calves could be the best classifying factor.

Patterns of lymph node recurrence after radical surgery impacting on survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma.

The aim of this study was to investigate how patterns of lymph nodes recurrence after radical surgery impact on survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma. One hundred eighty consecutive patients with thoracic esophageal squamous cell carcinoma underwent radical surgery, and the tumors were staged as pT1-3N0M0 by postoperative pathology. Lymph nodes recurrence was detected with computed tomography 3-120 months after the treatment. The patterns of lymph nodes recurrence including stations, fields and locations of recurrent lymph nodes, and impacts on patterns of survival were statistically analyzed. There was a decreasing trend of overall survival with increasing stations or fields of postoperative lymph nodes involved (all P<0.05). Univariate analysis showed that stations or fields of lymph nodes recurrence, and abdominal or cervical lymph nodes involved were prognostic factors for survival (all P<0.05). Cox analyses revealed that the field was an independent factor (P<0.05, odds ratio=2.73). Lymph nodes involved occurred predominantly in cervix and upper mediastinum (P<0.05). In conclusion, patterns of lymph node recurrence especially the fields of lymph nodes involved are significant prognostic factors for survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma.